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How is hepatitis C treated?

Hepatitis C virus is treated with all-oral medications. These pills, called antiviral medications, are usually taken once per day. These antiviral medications are extremely good at attacking the virus and preventing it from multiplying.

Antiviral medications were not the original treatment for hepatitis C. Before 2014, the only treatment for hepatitis C was called interferon and ribavirin, taken as weekly injections under the skin, plus pills. Interferon treatment caused many unpleasant side effects and was not usually successful. Today's antiviral treatments are extremely successful at curing the virus and have very minimal side effects.

Ribavirin (without interferon) is sometimes prescribed to be taken along with the new antiviral medicines. Most patients do not need ribavirin, but for certain patients, ribavirin is needed as extra help for the antiviral medications to have the best chance at curing the hepatitis C virus. Ribavirin has some mild-moderate side effects. Ribavirin is a pill taken twice per day, as 2 or 3 pills in the morning plus 2 or 3 pills at night, depending on the patient's body weight.

Why should people take antiviral medications for hepatitis C?

reduce the risk of developing cirrhosis (advanced scarring of the liver)

reduce the risk of developing liver cancer (hepatocellular carcinoma)

reduce the risk of liver failure and the need for a liver transplant

What does it mean to have a successful treatment? What is a Sustained Virologic Response (SVR)?

In an untreated state, the hepatitis C virus infects the cells of the liver and then continuously lives there, making copies of itself that circulate in the bloodstream. When antiviral medications are used, they can destroy the way the virus reproduces. The amount of virus in the bloodstream then decreases. The amount of virus in the blood is measured by a viral load (also called HCV RNA).

Treatment is successful when the viral load drops to undetectable levels, which means the virus cannot be detected in the bloodstream at all. The viral load becomes undetectable during treatment and remains undetected after treatment has ended. If there is still no detectable virus in the blood 12 weeks after the end of the treatment, the treatment was successful. This is called a Sustained Virologic Response (SVR).

A patient who has achieved an SVR is considered to be cured of the hepatitis C virus.

What are the names of the medications for treating hepatitis C?

There are many antiviral medications that are used to treat hepatitis C. Some are used alone, some are used in combination with each other, and ribavirin can be added to any of the medications on this list.

Antiviral medications in alphabetical order (not in order of preference):

Daclatasvir (Daklinza) + Sofosbuvir (Solvaldi)

Elbasvir/Grazoprevir (Zepatier)

Ombitasvir/paritaprevir/ritonavir + Dasabuvir (Viekira is the name of the entire combination)

Sofosbuvir (Solvaldi) + ribavirin

Sofosbuvir/Ledipasvir (Harvoni)

Sofosbuvir/Velpatasvir (Epclusa)

Sofosbuvir (Solvaldi) + Simeprevir (Olysio)

There are also more medications expected to be developed and approved.

How long is the treatment?

Most of the time, treatment is 12 weeks long. Sometimes treatment can be 8 weeks long, and occasionally it needs to be either 16 or 24 weeks long.

How likely is it that the treatment will cure my hepatitis C virus?

In general, hepatitis C treatment regimens have extremely high success rates. Many of the regimens are successful in curing more than 90 percent of people and some of the regimens are successful in 95 to 99 percent of people. All patients with hepatitis C should be evaluated for treatment.

Some patients may have a somewhat lower likelihood of success. For patients who may have a lower chance of successful treatment, their provider may tell them to take the medication for longer and/or add ribavirin to the medications that are used.

The medications may not work as well in some patients who:

have genotype 3 infection

were treated previously but not cured, which is called "treatment experienced"

have cirrhosis

have changes in their virus, called "mutations," that cause the virus to be resistant to medications. Mutations can prevent the medications from working as well.

How quickly will the medications work?

The medications will usually cause a very big drop in the viral load within the first two weeks. Some patients will see their viral load become undetectable very early, such as by the fourth week. For other patients, it can take longer until their viral load becomes undetectable. If the drop in the viral load is very slow then the provider may add ribavirin, and/or extend the number of weeks for the treatment.

What can people do to help the medications work best?

Take the medications every day

Stay in touch with pharmacy to be sure that all refills are ready on time

Take the medications exactly as prescribed (in terms of timing with food or other medicines)

Do not skip doses

Get all blood tests done on time

Go to all visits with providers as recommended

Tell the provider about all other medications that are being taken - including over-the-counter medicines, vitamins, herbs, and supplements

Complete the entire course of medication

What does it mean to relapse?

Relapse means that the treatment did not succeed in curing the virus. The medicine was able to clear the virus for a time, but then the virus came back. Re-treatment options should then be discussed with the provider.

How will my doctor monitor me during the treatment?

Your provider will meet with you during treatment to review how well you are tolerating treatment and review laboratory results. Laboratory tests help keep tabs on your health, track the viral load, and determine your response to treatment. You will be given specific dates to go get your blood tested at the lab during and after the treatment.

Side effects of antiviral medications

Hepatitis C antivirals have very mild or no side effects. Some of the side effects may be:

Nausea

Fatigue

Headache

Rash

Disturbed sleep (insomnia)

Side effects of ribavirin

Ribavirin can have side effects that are more noticeable and more common. These side effects are reversible so they will stop when the ribavirin is stopped.

Drop in red blood cell count (anemia)

Cough

Shortness of breath

Chest pain

Rash

Birth defects (harm to embryo or fetus of pregnant patients)

Ribavirin and birth defects

Ribavirin can cause birth defects, harming the embryo or fetus of pregnant patients, so ribavirin should not be taken during pregnancy. In addition, both the patient and their sexual partner must use birth control during the ribavirin treatment and for 6 months after it is completed.

What about patients with hepatitis C who also have hepatitis B?

Hepatitis B virus can flare in patients who are co-infected with hepatitis B and hepatitis C and are taking medication for hepatitis C. This has been reported as a potential risk for patients who are taking hepatiis C treatment and have underlying hepatitis B as well. The flare usually occurs within a few weeks after the patient starts taking medication for hepatitis C. Therefore, patients who have both hepatitis B and hepatitis C should be seen by a hepatitis expert before starting treatment of the hepatitis C; they may need to start taking hepatitis B treatment to avoid a hepatitis B flare.

Are there ways to cure hepatitis C other than with medications?

Patients sometimes ask whether there are ways to treat hepatitis C other than taking medicines. Currently, there are no vaccines to prevent hepatitis C. Once a person is infected, the only way to treat it is with prescribed antiviral medications.

Some patients worry that having hepatitis C means they will need a liver transplant. Only a very small fraction of people with hepatitis C require a liver transplant. By far, most people with hepatitis C never need a liver transplant. A transplant is performed only when damage to the liver is extremely advanced and the liver is unable to perform its basic functions. A transplant provides a new working liver, but a transplant does not get rid of the hepatitis C virus in the patient. Patients with a liver transplant still need antiviral medication to cure their virus.